Community Breastfeeding Initiative Application
To apply for a CBI Mini Grant from the Nebraska Breastfeeding Coalition, complete the following application and submit by June 22, 2018. Due to our funding source, CHI Health, we are only able to accept applications from communities in Nebraska. Preference will be given to those projects which are able to identify the impact and outcomes of the work.
Community or Organization: *
Your answer
Contact Name: *
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Contact Phone: *
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Contact Email: *
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Does your community have a local breastfeeding coalition? *
Required
Please list representatives from at least 3 of the following sectors that currently are involved or will be involved in the activities of this application: hospitals, primary care offices, employers, local public health departments, WIC, breastfeeding support groups, mothers and others. List member name, title, and organization/sector: *
Your answer
Briefly describe what your community assets and needs are regarding breastfeeding support. *
Your answer
Provide a brief description of your project/group and how it aligns with the Coalition's strategic plan. {Priority will be given to those projects that align with evidence based practices and best practice innovative ideas. Strategic plan can be found here: http://nebreastfeeding.org/what-we-do/strategic-plan/} *
Your answer
Briefly explain how you plan to sustain the work/group independent of this funding: *
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Please provide a brief description of how you will measure changes made by this funding (e.g., pre/post survey, attendance tracking, etc). *
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The CBI Mini Grant can support awareness, community building, and training activities.
Amount Requested (Up to $2,000) *
Your answer
Please provide a detailed budget for your activities: *
Note: Funds can not be used to train an individual, purchase food, or provide supplies for clinics.
Your answer
List activities with key dates/timeline. *
Your answer
Applications must be submitted by June 22, 2018 to be considered for this current grant cycle. Activities must take place between July 2018 and June 30, 2019. Accepted communities will be required to report progress at Coalition Quarterly Meetings (1st Tuesday of August, November, February, and May). A mid-point report will be due by January 15, 2019 and a final report will be due by June 15, 2019.
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